Toupet M
Centre d'Explorations Fonctionnelles Oto-Neurologiques, 10 rue Falguière, 75015 Paris, France.
Rev Laryngol Otol Rhinol (Bord). 2005;126(4):209-15.
The analysis of our vertiginous patients reveals that the likely existence of a pattern of symptoms related to a disturbance of the otolith organ responsible for detection of linear accelerations. Very often otolith pathology affects only certain directions of movement or tilting in relation to gravity. The various tests of the otolith function do not seem to identify all of these otolith deficits. It is possible that each individual test explores only partially the 4 otolith organs. Our otolith tests are still either too general, or, only focused on a part of a multi-directional function (and wrongly emphasizing a partial pathology). Thus, the history remains the finest diagnostic tool. The exploration of the otolith function has improved. These tests are not redundant. The subjective visual vertical tests the otolith function up to the vestibular cortex whilst the off-vertical axis rotation (OVAR) test explores the ocular otolith reflex. The myogenic otolith evoked potentials are saccule-collic. The cerebral cartography shows the various zones of cortical saccular activity and the tilt suppression test explores a reflex involving the cerebellar nodulus. However all of these tests are still nonspecific. There 'non-specificity' is similar to the non-specific nature of a free field hearing or the rotatory vestibular tests. The analysis of patient symptoms, using diagrams summarizing the principal clinical findings, or using a 3D software, facilitates the identification of the involved side, the affected organ (utricle or saccule) and to some extent the possible site of the lesion (just as a visual field would assist in identification of the retinal area affected prior to fundoscopy). Some otolith tests can be very sensitive albeit non-specific like the subjective visual vertical test. Others are more specific in identification of the organ and side affected like the otolith sacculo-collic evoked potentials. The choice of vestibular function tests is best based on the patient's particular symptoms. Thus a patient complaining of falling outwards is to be tested by offset rotations. A patient complaining of falling while going down in a lift is best investigated by the cortical vestibular otolith evoked potentials.
对我们的眩晕患者的分析表明，可能存在与负责检测线性加速度的耳石器官功能障碍相关的症状模式。耳石病变常常仅影响相对于重力的某些运动方向或倾斜方向。各种耳石功能测试似乎无法识别所有这些耳石缺陷。有可能每个单独的测试仅部分地探索了4个耳石器官。我们的耳石测试要么仍然过于笼统，要么仅关注多方向功能的一部分（并且错误地强调了部分病理情况）。因此，病史仍然是最好的诊断工具。耳石功能的检查方法已经有所改进。这些测试并非多余。主观视觉垂直线测试耳石功能直至前庭皮层，而离垂直轴旋转（OVAR）测试则探索眼耳石反射。肌源性耳石诱发电位是球囊-颈髓的。脑图谱显示了皮质球囊活动的各个区域，倾斜抑制测试探索了涉及小脑小结的反射。然而，所有这些测试仍然是非特异性的。它们的“非特异性”类似于自由场听力或旋转前庭测试的非特异性。使用总结主要临床发现的图表或3D软件对患者症状进行分析，有助于确定受累侧、受影响的器官（椭圆囊或球囊），并在一定程度上确定可能的病变部位（就像视野有助于在眼底镜检查之前识别受影响的视网膜区域一样）。一些耳石测试虽然是非特异性的，但可能非常敏感，如主观视觉垂直线测试。其他测试在识别受影响的器官和侧别方面更具特异性，如耳石球囊-颈髓诱发电位。前庭功能测试的选择最好基于患者的特定症状。因此，抱怨向外跌倒的患者应通过偏置旋转进行测试。抱怨在电梯下降时跌倒的患者最好通过皮质前庭耳石诱发电位进行检查。
